Rinderpest can be a devastating disease of cattle, buffaloes and wildlife species. It has caused
pandemics that killed a high proportion of the host populations in many countries. However, due to
the availability of an excellent vaccine, and concerted national and international effort, the disease has
been confined to a few foci of residual infection in Africa and Asia. Nevertheless, rinderpest remains
a serious cause of economic loss arising from:

Direct losses due to the disease itself. These are at present relatively small in global terms.
However, serious outbreaks do occur from time to time, and these kill a high proportion of
the cattle and buffalo population in areas where vaccination programmes have not been
effective. All too often, the people most affected are the among the most economically
vulnerable groups in remote areas. The losses are not confined to cattle owners and livestock
production. Cattle have important roles in farming systems, through draught power and acting
as the capital reserve for the farm. Even where cattle production is not the dominant
economic activity, typically many poorer people depend on cattle owners for their livelihood.
Rinderpest also kills large numbers of wild animals, which cannot be protected by
vaccination, but which are of great importance to the economy of some the remote areas
where rinderpest is most likely to occur. The disease is a serious threat to restricted
populations of endangered wildlife and income from tourism.

Cost of control. Rinderpest vaccine is inexpensive, costing from US$ 3.00 to US$ 16.00
per hundred doses. However, the cost of delivering the vaccine from store to animal is
generally very much higher. The vaccine must be stored in a deep-freeze and kept
refrigerated until it is reconstituted, which requires a “cold chain” network from store to
vaccination point. Teams of vaccinators have to be supervised and supported by transport,
subsistence allowances and other logistics. Serological monitoring should also be carried out
to ensure that vaccinated animals are being immunised. Cattle owners face costs in bringing
their animals to vaccination sites, which can have a high opportunity cost in terms of other
farming activities, and through production loss caused by the disturbance to the animals.
Gathering animals at vaccination sites also creates ideal conditions for the transmission of
diseases such as rinderpest itself, CBPP, FMD and others. The overall cost of vaccination
varies according to the situation, but the national average cost would rarely be less than US$
0.50 per animal vaccinated. It is estimated that there are about 500 million bovines in the area
subject to rinderpest control. Even if only 20% of these were vaccinated each year, the most
conservative estimate of total annual costs would be US$ 50 million per year.

Effects on trade. While most of the countries affected by rinderpest would be excluded from
world markets by other zoosanitary restrictions, there is important regional and within-country
cattle trading, and this is periodically disrupted by rinderpest. Other trading opportunities,
e.g. from India to the Middle East, are permanently restricted. This results in loss of
economic welfare to both potential sellers and buyers. Moreover, the cost of enforcing
movement control and quarantine procedures is significant, even where they are only partly
effective.

In addition to these actual losses resulting from the continued existence of rinderpest, there
remains a risk of major epidemics, which would result in much greater costs. In countries that have
not experienced rinderpest for some time, there is constant pressure to reduce expenditures on
vaccination. This trend was responsible for the major rinderpest epidemic in Africa in the early
1980s, which killed at least one million cattle.
Until rinderpest is eradicated from the world, these costs will continue. It has been shown that the
cost of completing eradication for most countries would be less than the costs of continuing
vaccination and other control measures. When any individual country eradicates rinderpest from its
own territory, it is in a position to replace mass-vaccination strategies with reliance on emergency
preparedness, through ensured early-warning and early-reaction, applicable to all epidemic diseases.
However, the tendency is to continue vaccination as long as the threat of re-introduction remains, and
the potential cost-saving therefore fails to materialise. When such vaccination programmes fail to
generate a sufficiently high level of herd immunity, experience has shown that it is nearly impossible
to prevent the spread of rinderpest in susceptible cattle populations in most of the affected area. In
the face of an outbreak, livestock owners either try to move their animals away from the threat, or
sell cattle to reduce their exposure to loss. This results in the rapid distribution of infected animals
through the area, and can cause epidemics.

GREP is designed to provide a mechanism by which countries can eradicate rinderpest in a
concerted and co-ordinated programme, and thereafter benefit by saving the very considerable
recurrent cost of present control programmes.

The importance of adherence to the OIE pathway is much more than symbolic. Countries will
only have the confidence to stop vaccination if there is international verification of neighbouring
countries' freedom from disease and infection. The OIE pathway, which requires the cessation of
vaccination combined with disease surveillance, provides the only practical approach to the disclosure
and elimination of hidden foci of infection.

Rinderpest control professionals tend to refer to remote areas as inaccessible or as “no-go
areas”. These terms seem to mean in practice that the areas are not accessible to conventional methods
of service delivery implemented by government personnel. There are a variety of methods for
delivering services to most of these areas. Rather than categorise areas as inaccessible, a negative
and absolute term, it is perhaps more useful to talk about remote, marginalised areas or communities.
Marginalisation simply means that the areas or communities have been excluded from the mainstream
political, sociological and economic systems of their country. They are at the margins of society and
have been left out by development. Insecurity often arises hand-in-hand with marginalisation. In a
sense, the few truly inaccessible areas with severe security concerns are just extreme cases of
marginalisation. Marginalisation is a relative term which immediately calls attention to the fact that
there are special social, economic, cultural or political concerns which make the area unique. This
recognition facilitates the design of development programmes adapted to local conditions.

This paper will provide examples of some solutions for animal health service delivery to
marginalised communities. The paper makes the fundamental assumption that rinderpest eradication
is a complex socio-economic development activity rather than a simple technical intervention. There
are no quick technical or funding fixes that will lead to rinderpest eradication from remote,
marginalised communities. It is not a question of more transport, fuel or per diem for the same old
systems. On the other hand, if the basic methods and approaches are rethought, medium-term efforts
to establish appropriate service delivery will lead to the sustainable eradication of rinderpest. This
requires courage on the part of decision makers as well as a willingness to test new ideas and accept
change.

As the author's experience is mainly in Central and East Africa, this region will be used to
illustrate the ideas introduced in the paper. In recent years, it has become apparent that the endemic
reservoirs of rinderpest (RP) in East Africa are remote, marginalised pastoral communities. This
situation has come about as a result of the reality that these communities lack access to veterinary
services adapted to the specialised conditions of pastoral life. This lack of access to services is simply
another symptom of marginalisation and is not necessarily a fact of life for pastoral societies. It is
perhaps noteworthy that no rinderpest has been reported from West Africa since 1988 where
pastoralism is more a part of the main stream socio-economic system. The success of the present
rinderpest eradication effort in East Africa depends upon frank recognition of all remote endemic foci
and the implementation of more appropriate disease surveillance and vaccine delivery programmes
in these specialised environments.

The first step in designing a programme for a marginalised area is to identify what are the
specialised constraints and why the more conventional methods for service delivery have failed. Why
are the communities marginalised? Sometimes this requires national and international planners to
overcome a few stereotypical ideas and take a fresh look.

Methodologies and strategies now exist for reaching remote pastoral communities with
preventive and curative animal health services in a highly effective manner. In many ways, these
development approaches were pioneered in West Africa and Asia, however, important contributions
have come from East Africa as well. Some methods that are relevant to rinderpest eradication
include:

community dialogue and contracts in conventional vaccination programmes

participatory service delivery (Community Animal Health Workers)

sanitary mandates and cost-recovery

community-based veterinary practice

participatory epidemiology

Each of these topics will be discussed separately, however it is important to point out that the
best solution is usually a combination of several approaches implemented simultaneously. It is also
important to understand that more comprehensive solutions that offer service delivery for a number
of priority animal health problems will probably be more successful than a simplistic intervention
against rinderpest alone. Often in rinderpest endemic areas, the socio-economic impact of rinderpest
ranks well behind other diseases such as contagious bovine pleuropneumonia, trypanosomiasis and
even anaplasmosis. To be well accepted, the service delivery programme must meet the community's
priority needs in addition to the needs of the rinderpest eradication campaign.

Community Dialogue and Community Contracts

There are two main reasons for vaccination campaign failure in pastoral areas. The first is
that the organisation of the campaign does not take into account the basic constraints facing the local
population. The result is that vaccination is offered at inappropriate times, in inappropriate places
or in another manner that does not allow the cattle owners to participate. The second cause of poor
vaccination campaign results is a failure to install confidence in the beneficiaries as to the value of
the campaign (i.e. that the campaign responds to the cattle owner's needs).

Both of these shortcomings can be overcome through a process of consultation that has been
termed community dialogue. In the case of conventional vaccination campaigns, this means that
campaign planners and implementors should conduct a series of meetings with the beneficiaries in the
context of their local decision-making bodies. It is important that these meetings are conducted with
the actual cattle owners and their traditional representatives. Government appointed chiefs do not
always have the full support of the cattle owners and should sometimes be de-emphasised in this
process. The meetings should be conducted in the local community's language with translation for
any visitors. In these meetings, the groups sit down, frankly express their concerns and try to reach
a common understanding about what is needed.

Once a common understanding is reached, an agreement that is termed a ‘community contract’
can be made. This is an active agreement where each side clearly states in their own words what is
to be done by them. Often, the agreement includes components other than rinderpest vaccination.
It is important that both sides are realistic and only agree to steps that they can actually fulfil. One
of the most common mistakes made by inexperienced community development professionals is the
creation of ‘false expectations’. Marginalised communities have experienced many disappointments
and a visit by outsiders raises hopes. A simple suggestion or off-the-cuff statement can easily become
a promise in the community's eyes. The community will long remember broke promises, intended
or not, and the veterinary team may not get a second chance.

Participatory Service Delivery (Community Animal Health Workers)

The marginalised areas of East Africa are characterised by mobile, extensive production
systems and sometimes lack roads or have security concerns that limit access to outsiders. This
makes service delivery by conventional methods, even after community dialogue, difficult. In order
to reach a sufficiently high percentage of the population for disease eradication, conventional methods
should be augmented with participatory service delivery.

The term participatory service delivery refers to trained local community representatives
implementing services in the field under the guidance of, or in collaboration with, professional service
delivery institutions. Over the years, many different variations of this approach have been tried.
There is no one ideal approach that can be recommended as each community is characterised by
unique traditional institutions, customs and experiences. One general model that has worked well for
animal health care in a broad spectrum of cultures is the Community Animal Health Worker
(CAHW). Although there are no absolute rules in how to go about setting-up a community animal
health worker network, there are several general principals that should be followed to ensure success
and sustainability.

The first principal is to get help from experienced community developers and trainers at the
outset. Although many of the activities and concepts may seem simple, self-evident or even trite,
community development is a deceptively complex undertaking. Community development is largely
dependent on specialised interpersonal skills, and these skills are learned by experience.

Community Animal Health Workers are elder-supervised, community employees. They are
selected by their communities and trained by the veterinary authorities through a process of
participatory dialogue. The veterinary establishment does not pay them, they are supported through
their own activities. The veterinary establishment exercises its authority through its right to set
standards for training and to revoke a CAHW's status. The key factors in insuring that CAHWs work
properly are that:

they are cattle owners themselves;

they are not paid a salary;

they are supervised by the community elders (e.g. parents, uncles, cousins);

they are treating their own clans cattle;

they are under the technical supervision of a veterinary professional.

In this family situation purposive misbehaviour (over-charging, under-dosing, use of false
drugs) is extremely rare.

The Thermostable Rinderpest Vaccine Transfer of Technology Project (TRVTT Project)
implemented a number of pilot field programmes to deliver heat stable rinderpest vaccination through
CAHWs to remote, pastoral communities. The communities included the Fulani of Cameroon, the
Karamojong of Uganda, the Afar of Ethiopia and the Arab and Fulani pastoralists of Salamat, Chad.
The Project also provided support for the establishment of the UNICEF de-centralised animal health
care programme in Southern Sudan.

In each of the communities, the TRVTT Project began by conducting participatory rural
appraisals to gather existing veterinary knowledge and to establish an information base for the design
of a locally-adapted community animal health programme. The design was agreed upon in discussion
with the participating communities and implementing partners. No two programmes were exactly
alike. The implementing partners varied by location and included government veterinary and
extension services, non-governmental organisations and in the case of Chad, a private veterinarian.
Initially, governments proved to be extremely difficult to convince as to the appropriateness and
effectiveness of community-based rinderpest vaccination, however their opinions rapidly changed once
they saw the programmes in action.

During the TRVTT Project's five years of operation, the Project found that the more time that
was invested in dialogue with the communities and implementing partners, the better the programme
performed. The key to smooth operation was a clear and active community contract that defined each
party's contribution at the outset. Often, it was very difficult to convince implementing partners of
the importance of firmly stating the conditions for participation in an open manner. They feared that
the communities would refuse. Actually, experience proved that the tougher the negotiations were
made, the more quickly the communities responded in a responsible manner. The communities always
tested the resolve of the facilitators. It was essential to listen patiently and respectfully, but to be fair,
firm and clear in the conditions for participation. The conditions for participating in the programme
evolved over the years and at the end of the Project they were:

no credit for drugs in any form;

market prices for curative treatment and non-compulsory vaccination;

partial cost recovery for rinderpest vaccination;

an initial contribution towards the cost of training and equipping the CAHW.

The community was required to state all the conditions in their own words before they were
asked to select a candidate. The community contribution towards training and equipping the CAHW
ranged between US$ 20 and 50. Alternatively, the equipment kit did not include drugs, these had to
be purchased, and the CAHW trainee was advised to bring cash for this purpose. If the trainee came
to the training without the initial contribution, or was unable to purchase drugs, he was trained but
was not given his kit until he had raised the money. In most cases, the few CAHWs that did not have
their contribution on the registration day of the training course were able to raise sufficient funds by
graduation day.

The trainings lasted seven to 10 days. The course emphasised a few basic concepts and
practical skills. The last three days of the course focused on rinderpest vaccination and culminated
in a full scale vaccination session organised and implemented by the trainees. After the training, it
was important to continue to meet with the CAHWs and their communities to reinforce the
community contract. Often these meetings included ad hoc negotiations for cost-recovery on
rinderpest vaccination in countries that did not have national cost-recovery policies. Even the most
notorious communities in Karamoja agreed to pay reasonable vaccination labour charges to their
CAHWs after a single face to face meeting.

Community-based rinderpest vaccination proved to be a success. In the three countries where
the government was an active implementation partner (Uganda, Ethiopia and Chad), there were
immediate calls to expand the programmes within the remote pastoral areas after only the first season
of operation. In the case of Cameroon and Ethiopia, the national sero-monitoring programmes were
particularly active in following the vaccination efficiency of the programme. The data is presented
in Table 1. Please note that the CAHWs were at least as effective as the best national veterinary
services.

The real advantage of community-based vaccination programmes is that they cover the key
cattle populations for rinderpest virus maintenance at a low cost. For example, the Ethiopian
Veterinary Service allocated one vehicle and two staff to follow the CAHW programme in Afar and
in the first season of operation, the CAHWs vaccinated 70,000 cattle. In the same period, the
veterinary services allocated 14 vehicles with 4 staff each to cover southern portion of Afar and only
achieved about 140,000 vaccinations. More importantly, the CAHWs stopped rinderpest virus
circulation in their community after only a single campaign despite major outbreaks in the
immediately adjacent area to the North. At present, the CAHW programme in Afar is being replicated
to these northern areas.

Although all the CAHW vaccination programmes were immediate successes, there remains
concerns regarding the sustainability of the monitoring and follow-up of the CAHWs in the two
countries where the government services were entrusted with this responsibility (Uganda and
Ethiopia). In Uganda, there proved to be difficulty in providing sufficient funds for fuel and per diem
for the monitors. The programme in Ethiopia has not experienced this difficulty to date, however
it is feared that monitoring constraints will arise as the approach becomes more routine.

Table 1: Community Animal Health Worker Vaccination Efficiency

Community

Delivery System

Efficiency

Fulani, Cameroon, 1993

CAHWs, No Cold Chain

86%

Afar Ethiopia, 1995

CAHWs, No Cold Chain

84%

Afar Ethiopia

Conventional Campaign, Cold Chain

72%

Non-Thermovax-Based National Campaigns Throughout Africa

Conventional Campaign, Cold Chain

60 - 85%

Table 1: Vaccination efficiency is the percentage of sero-negative vaccinates which mount a protective immune
response as a result of vaccination. For the CAHWs at Sabga, the efficiency was measured by pre-vaccination
and post-vaccination serology on ear-tagged cattle. For the national campaigns and the CAHWs in Afar,
efficiency was taken as the percentage of ear-marked cattle which actually possessed protective antibody levels.
The data for non-Thermovax-based national campaigns is extracted from the seromonitoring report for 1993 of
the Pan African Rinderpest Campaign which included detailed data from 22 countries. In the Sabga trial
program, a total of 24,000 cattle were vaccinated and a charge of 80 CFA (0.29 USD) was instituted after the
first 14,000 vaccinations. This is approximately equivalent to 2 Ethiopian Birr, 300 Ugandan Shillings or 15
Kenya Shillings at rates of exchange in effect at the time of the trial. The Afar group of 22 CAHWs vaccinated
70,000 cattle in their first season or slightly more than the population estimate for their community.

As a solution to the sustainability of monitoring, the TRVTT Project has recommended that
monitoring and re-supply of the CAHWs be privatised. In Uganda, this was partially accomplished
through allowing the veterinary service personnel to trade drugs with the CAHWs on a commercial
basis. This improved follow-up and re-supply, but total privatisation of the CAHW network by
bringing in private veterinarians with vaccination contracts would further enhance the long-term
sustainability.

The programme in Chad was implemented at the outset in the context of a private veterinary
practice with a rinderpest sanitary mandate. Problems with sustainability are not anticipated. This
programme is discussed in detail below in the section of community-based veterinary practice.

Sanitary Mandates (Vaccination Contracts)

Assigning rinderpest vaccination contracts for defined regions and cattle populations to private
veterinarians has been shown to result in herd immunity levels consistent with rinderpest eradication.
In addition to providing good vaccination coverage, vaccination contracts assist with the establishment
of private veterinary practice in extensive animal husbandry systems. Contract vaccination is now
underway in several Sahelian countries including the remote areas of Chad. Some of these
environments bear many similarities to the rinderpest endemic areas of eastern Africa including an
element of insecurity. Contract vaccination programmes should be encouraged on a trial basis in
eastern Africa and Asia.

Systems of verification such as ear-marking, receipts and serological surveillance must be put
in place as part of the contract vaccination programme. The veterinarians are paid partly on the basis
of the number of head of cattle they vaccinate - a quantity incentive. The remainder of their
remuneration is based on bonus payments for 80% ear-marking and 80% herd immunity levels in
vaccinated herds - a quality incentive. A sero-surveillance team inspects all contract vaccination at
the end of each season. A contract veterinarian can generally cover his costs on the basic per head
payment, but his profits really come from the bonuses for good ear-marking and serological results.
Thus, both the quantity and quality of work are rewarded in a verifiable system. Experience has
shown that more cattle can be properly vaccinated at less cost using contract vaccination.

An important element of privatised rinderpest control is cost-recovery. Initially, the Pan
African Rinderpest Campaign feared that cost-recovery would depress vaccination coverage. However
when cost-recovery is used to generate quantity-based incentives for vaccinators (community-based,
government or private veterinary teams), vaccination coverage improves considerable. The reason for
this is that the vaccinators are motivated to do their utmost to convince the majority of cattle owners
to vaccinate their herds. After all, every cow the vaccinators miss is money lost from their pocket.
Thus, one finds quantity-based incentives from cost-recovery charges result in proper communication
and community dialogue leading to more effective vaccination coverage. It is not unusual to find
contract veterinarians who visit reluctant herders 4 or 5 times or simply until they agree to purchase
vaccination.

Problems of low vaccination coverage in many, but not all, marginalised areas could be
solved by well thought-out contract vaccination programmes. The limiting factor would be the level
of security risk relative to the amount of private investment required and the potential profitability.
Key elements for success are:

Selection of contract holders who can cope with local constraints and who can be accepted
by the target communities.

Appropriate systems of verification such as:

a progressive cost recovery programme

receipt systems

vaccination cards

field monitoring and sero-monitoring

The next section will suggest methods for integrating contract vaccination into communitybased
animal health programmes. This approach reduces the amount of veterinary practice investment
required in transportation and reduces operating costs. The resulting community-based veterinary
practice is less vulnerable in insecure areas since it works through local community representatives
who can travel safely where outsiders cannot.

Community-Based or Pastoral Veterinary Practice

The term community-based veterinary practice refers to private veterinary practice integrated
within the community through participatory service delivery schemes. In this approach, the
veterinarian uses participatory methods to work towards becoming a respected member of the
community. He invites members of the community to work with him in designing and implementing
the practice.

The integration of CAHW networks within private veterinary practices offers tremendous
potential for expanding the market for private veterinary practice in remote areas and increasing
practice profitability in other regions as well. This increased profitability will result from increased
sales volumes and reduction of operating and investment costs for transportation. The final outcome
is a local veterinary practice delivering its services through a CAHW network or to organised
community associations which the veterinarian himself has helped to create. The individuals assisting
their community and veterinarian are not paid a salary by the practice. They are remunerated by the
community at the time they actually provide their service. Thus, one should consider them as
employees of the community working under the technical supervision of the veterinarian. From a
business perspective, these CAHWs are acting as commission men carrying veterinarian's services to
areas where it would not be economical for the veterinarian to establish a formal, permanent presence.

Currently, the concept of a community-based veterinary practice forms the basis of a pilot
project in one of the remotest regions of Chad, Salamat, along the border with the Central African
Republic and Sudan. The programme has two objectives. The first is to provide adequate vaccination
coverage to generate sufficient herd immunity to protect the cattle population against the introduction
of rinderpest from Sudan. The second objective is to create a private pastoral veterinary practice that
is integrated within the local transhumant Arab and Fulani community. The clients of the practice
are highly mobile and only spend 5 to 6 months of the year in the practice area. The veterinarian has
received a rinderpest vaccination contract to be implemented through the CAHW network and a stock
of heat stable vaccine.

In Salamat, the community-based veterinary practice works through CAHWs trained jointly
by the private veterinarian and the extension services. The private veterinarian was prominent in the
community dialogue and training process in order to build a strong relationship and sense of loyalty
between the veterinarian, the CAHWs and the community. The CAHWs are highly successful in
generating good vaccination campaign participation and collect the equivalent of US$ 0.15 per
vaccination from the cattle owner. They are allowed to retain approximately US$ 0.02 of this fee.
The rest (US$ 0.13) is passed on to the veterinarian. The veterinarian receives the heat stable
rinderpest vaccine, vaccination cards, and official receipt books from the government free of charge.
In addition to the US$ 0.13 per vaccination that the veterinarian receives from the herd owner, he
receives a payment of about US$ 0.08 per head vaccinated from the government. This second
payment is made after evaluation of the work using seromonitoring to measure vaccination efficiency
and spot inspections to verify proper documentation and marking of vaccinates. In the coming
campaign, 1996–97, the herders' contribution will increase to US$ 0.20 and the government's
contribution will be reduced accordingly. This programme has met with excellent initial success and
should prove to be a sustainable solution. Some profit projections based on actual sales margins, loan
and depreciation charges as well as estimates of operating costs are presented in Table 2. Market
research indicates that these sales volumes are reasonable targets.

Originally, the programme was to be evaluated from both a technical and financial stand point
at the end of its first season of operation in May/June, 1996. Regrettably, the veterinarian was killed
in a car accident in April, 1996. Although the Veterinary Services of Chad were initially reluctant
to permit the pilot programme, they were very impressed with the preliminary results and are
committed to continuing the proogramme.

The single greatest investment cost for veterinarians going private is transport. If one reviews
the balance sheets in loan proposals to privatisation programmes one realises that in general, the loss
of the vehicle through accident or theft is the single greatest business risk facing a veterinarian who
establishes a mobile practice. The community-based approach reduces transport needs with one or
two used motorcycles being sufficient. This in turn reduces risk and should make contract vaccination
feasible in moderately insecure environments where theft is common.

Participatory Epidemiology

In remote, marginalised areas, it is frequently difficult to carry out classical laboratory-based
epidemiology. Serological data from remote pastoral cattle populations is often difficult, if not
impossible, to interpret due to the partial vaccination coverage and incomplete marking of vaccinates
practised in the past. Sample collection infrastructure for both serology and antigen detection is
usually poor. Thus, an over-dependence on laboratory methods often to an underestimation or
negation of the prevalence of rinderpest in remote areas.

Table 2: Salamat Veterinary Practice Profit Projecitons

Activity Level

vaccinations per Season

Medicine Sales (CFA per month)

Profit (Loss) in CFA

1. High

100,000

2,000,000

4,666,500

2. Moderate

50,000

1,000,000

1,046,500

4. Moderate

45,000

800,000

(27,500)

4. Low (no RP vacc)

12,000

1,600,000

(1,500)

Table 2: At the current rate of exchange 500 CFA equals US$ 1. Projections include all operating and finance
costs for the practice. The vaccinations column covers both rinderpest and non-compulsory vaccinations.
Except for Case No. 4 where income from RP vaccination is not included, it is assumed that about 80% of the
vaccinations will be rinderpest vaccinations. The medicine sales column represents the sales figures for the
entire practice. A 27% margin over cost, as calculated from actual sales figures, is assumed for the projections.
PROMEVET, a large drug wholesaler, reported that individual traders sell up to 1,000,000 CFA in medicines
per week in Salamat during the height of the season. This practice has the veterinarian two veterinary
assistants and a CAHW network as marketing structure. Thus, sales projections are conservative. The last
two cases represent break even calculations: Case No. 3 gives the sales volumes necessary to break even with
a rinderpest sanitary mandate whereas Case No. 4 indicates the amounts on non-compulsory vaccination and
medicine sale necessary to break even without a vaccination mandate.

The techniques of participatory rural appraisal offer key adjuncts to laboratory-based
epidemiology. Normally, pastoralists have a very well developed knowledge of clinical diagosis
based on symptomatology and patterns of transmission, particularly in regard to major epidemic
diseases such as rinderpest. They can very accurately recount the local history regarding rinderpest
and often are the first to recognise and report the disease. The problem is that all too frequently
nobody listens.

Participatory techniques have been developed specifically for rinderpest epidemiology. The
most notable is participatory disease searches where herders and other key informnts are interviewed
as to the incidence of major animal disease at present and in the past. The investigation is conducted
with an attitude of both respect and scepticism. The technique uses open-ended questions which do
not suggest any disease names. If the respondent volunteers information about rinderpest, he is then
asked to describe the disease in detail and probed to establish his knowledge and the internal
consistency of his report. All reports are cross-checked and major trends in the data noted. This
information can be used to elucidate the mechanisms of virus survival in a region, construct a
rinderpest time line or history, and is essential to making accurate interpretations of serological data.
It is also a powerful tool for the trace back of suspected outbreaks of rinderpest to pockets of active
disease for laboratory investigatin.

Laboratory confirmation of outbreaks and genetic analysis of viral isolates are powerful tools
in rinderpest epidemiology. Unfortunately in extensive settings, they can only prvide snap-shots of
rinderpest activity. Laboratory confirmation of isolated outreaks is comparable to the sighting of
icebergs; ninety percent of the danger lurks below the surface. Participatory epidemiology allows
rinderpest control authorities to fully delineate the danger and provides and accurate information base
for rinderpest eradication. It is also a valuable and cost-effective tool for the verification of
vaccination campaign impact and freedom from rinderpest disease.

Sustainability of Participatory Service Delivery and Privatisation

Community-based programmes overcome many of the problems associated with the
sustainability of service delivery in remote areas by making the communities responsible for
supporting the costs of sservice delivery. The main concern which remains to be addressed is the
sustainability of the monitoring and re-supply of community based programmes. It is important to
note that the non-governmental organisations (NGOs) have been leaders in the field of community
development and participatory approaches. Perhaps this is a result of their smaller size, flexibility
and willingness to experiment with new approaches. At any rate, adoption of participatory
approaches by government institutions has been a slow process. Support for CAHW programmes is
good in some countries, however, this is usually associated with a major project input. True
sustainability implies that the activity can stand on its own in the absence of donor or NGO
intervention. In the present economic climate in Africa, sustainabillity for community programmes
probably implies their ability to function in the absence of government intervention as well.

This was what led to the experiment of privatised and community-based service delivery in
Salamat, chad. This is a new initiative and the author believes that the future of both privatised
service delivery in remote, extensive areas and the sustainability of the CAHW approach in Africa
depends on an appropriate belending of privatisation and participation.

It is essentilally impossible to conceive of profitable private veterinary practices in remote
areas without local intermediaries. In traditional veterinary circles, concerns have been voiced that
CAHWs pose a competitive risk to the privatisation of the veterinary profession, that they fill market
niches which the veterinarian will need to survive. Our experience has suggested just the opposite.

Far from being competitors, CAHWs are essential allies for the veterinary profession and are
the bridge to successful ‘private pastoral veterinary practice’.

Some individuals have questioned the susttainability of rinderpest sanitary mandates due to the
fact that they are a donor funded programme. Just as with all other service provision, cost-recovery
is essential for the long-term sustainability of compulsory disease control whether implemented by the
government or the private sector - this was the lesson of JP-15. Others have raised the issue that
rinderpest vaccination will cease in many areas and that the veterinary practices in remote areas will
become non-viable. The experience in salamat indicated that the rinderpest mandate greatly facilitated
establishment of the practice, but was not essentially to the long-term sustainability of a communitybased
veterinary practice (see Table 2). It is also foreseen that when vaccination against rinderpest
is withdrawn, sanitary mandates for other diseases such as contagious bovine pleuropneumonia will
be put in place.

Suggestion for Project Preparation

The following points have been stressed in regard to sustainable solution to rinderpest
eradication in marginalised areas:

the need for guidance from experienced community development professionals,

the over-riding importance of intensive community dialogue,

the importance of self-sufficiency and sustainability,

the necessity of full cost-recovery or privatisation where ever possible.

One should note that this combination stresses experienced technical assistance (local, NGO,
or commercial) and calls for very little in the way of infrastructure or inputs. Thus, appropriate
projects proposals are heavy on personnel and light in the way of equipment, buildings, or material.
This runs counter to many donors' preferences at present but does make for better, more sustainable
projects. The objective is to develop self-sufficient community institutions to facilitate access to
inputs (including rinderpest vaccine) and to make available skilled veterinary labour at real market
prices. The limiting factor in most participartory projects is the availability of trained and experienced
facilitators to conduct communtiy dialogue, to monitor implementation in the field, and to train and
guide counterpart staff who are new to the participatory approach. One of the key factor for the
success of veterinary privatisation programmes is also guidance and clos follow-up in the field of
loan programme participants by skilled experts who understand private enterprise. Donors need to
recognise that the poicy reforms of privatisation and participation necessitate not only reform of
national budget, but project budgets as well.

Policy Reform and Legislation

In many countries where CAHW and community-based vaccination programmes opeate, they
do so without specific legal provisions and protection. Often they operate at the discretion of the
Director of Veterinary Services or the local district authorities. This situation is not conductive to
good sustainability and presents an investment risk to private veterinarians who wish to incorporate
community-based approaches in their practices.

Governments need to formally recognise th nuique requirements of veterinary service
delivery to remote and marginalised communities in their veterinary legislation and regulation. Two
reforms are key:

First, the pivotal role of the CAHW in providing services under the
supervision of veterinary professionals against major compulsory any noncompulsory
diseases should be recognised, defined and protected at the
national level. These provisions should include the application of injectable
antibiotics, trypanocidal drugs, and vaccines.

Secondly, the ability of public veterinary services to contract or mandate the
private and community-based sectors to provide compulsory vaccinations and
veterinary inspections should be recognised and facilitated.

Progress Towards the World Without Rinderpest - Results in Remote Areas

Since 1988, RP in Africa has been confined to eastern Africa. Since that time, the areas or
communities generally recognised to be affected endemically have been southern Sudan, the Iteso-Karamojong
peoples of Kenya and Uganda, north-eastern Ethiopia (Afar), and the areas bordering
Sudan to the West of Lake Tana and in the south-west of Ethiopia. More recently, outbreak
recognition and genetic analysis of isolates indicates that north-eastern Kenya is endemically infected
with a separate lineage of rinderpest virus. This is probably not new endemic territory, just newly
recognised endemic territory. As the first step in eradication is frank recognition of endemic areas,
the news from Kenya represents progress. All of these areas are of course remote, marginalised
pastoral communities.

Significant progress has been made in Ethiopia. Rinderpest has not been detected in the areas
to the West of Lake Tana or in most of the Afar region of Ethiopia despite extensive participatory
disease searches. This is partly the result of a sound eradication strategy based on open rinderpest
reporting, epidemiological risk classification and a rational use of resources. Also in southern Sudan,
rinderpest is controlled in many areas and we can now talk about specific pockets of viral activity
rather than broadly affected areas. This is largely due to the implementation of de-centralised animal
health care by UNICEF and the NGOs with rinderpest control based on CAHWs vaccinating with
heat stable vaccine. The most prominent pocket in southern Sudan is the Toposa region, a community
of the Iteso-Karamojong cluster. The situation in the rest of the Iteso-Karamojong area remains murky
as active or participatory disease searches are not practised.

The success in the Afar region is perhaps the most striking example of the impact of
participatory techniques in remote, marginalised communities. Here, participatory approaches were
integrated into the conventional vaccination campaign and participatory service delivery by CAHWs
was established in some sub-communities. The first step was to identify a regional co-ordinator who
had the necessary sensitivity and concern for local constraints, as well as the interest to take up the
challenge of rinderpest eradication from the area. Next participatory rural appraisals were conducted
in conjunction with the regional co-ordinator to identify local needs and constraints. Thereafter,
appropriate programmes of communication and community dialogue, as well as training of community
members as CAHWs were implemented. All conventional vaccination activities were conducted in
close consultation with the participants. The results are that in only three years since the first
participatory rural appraisals, rinderpest is close to eradication from this once ‘inaccessible’ region.
The first year of this three year period was almost entirely dedicated to study, strategy formulation
and preparation. At present, only 5 of 29 weredas are considered as infected and it is anticipated that
after the next campaign year these areas will be cleared.

Conclusion

This paper has attempted to suggest appropriate veterinary service delivery solutions for
remote, marginalised communities that will lead to sustainable rinderpest eradication. The processes
of privatisation and participation are both feasible and essential to service delivery in extensive areas.
Privatisation is the sustainable solution to supervision of community animal health programmes while
at the same time, private veterinary practice could not hope to be economically viable in extensive
environments without trained and loyal local intermediaries. To obtain fully effective programmes,
progressive cost-recovery for rinderpest vaccination starting with charges to at least cover field labour
costs should be implemented without delay. Far from discouraging good vaccination coverage, costrecovery
enhances participation. The programmes implemented to date have shown that these
approaches are realistic, practical and effective.

Implementation of these approaches on a wide scale will require intensive dialogue between
community development specialists, decision makers and field veterinary professionals to achieve a
common understanding and effect the necessary policy reforms at both the national and international
level.

The Pan African Rinderpest Campaign has restricted the rinderpest virus to endemic foci in
East and Sub Saharan Africa. These foci are all located in remote, marginalised and risk prone areas.
These areas have been termed special action areas for rinderpest control and eradication. The
characteristics of these areas tend to preclude the successful implementation of conventional
vaccination projects. It is now realised that approaches which use local participation and are
community-based are more likely to succeed in these areas. Participatory rural appraisal tools are
designed to facilitate such an approach.

The UNICEF / Tufts University livestock project working with Operation Lifeline Sudan in southern
Sudan has taken a participatory approach to the elimination of rinderpest and the provision of animal
health services. This process has been greatly assisted by the development of thermostable rinderpest
vaccine. The paper gives a brief description of the project, records some of the successes achieved
and highlights the major lessons learnt from the process.

The paper argues that participatory and community-based approaches should be used more
widely in special action areas within Africa and globally in order to ensure eradication of the
rinderpest virus.

1. Introduction

Since the introduction of rinderpest into Africa in the 1880s and the resulting pan African
epidemic, there have been two programs organised to control and eradicate the disease from the
continent. Joint project 15 (JP15) was the first, started in 1962 by the Organisation of African Unity
(OAU) and the bilateral donor agencies. At it's close fifteen years later, rinderpest had been confined
to the Sudan Ethiopia border and the Niger river delta in Mali. JP15 failed to remove these remaining
endemic foci for several complex reasons outlined by Mariner et al 1994. Two of the reasons were
as follows :-

many of the endemic sites were inaccessible, marginalised, insecure areas inhabited by
relatively independent transhumant and nomadic pastoral populations

methods of vaccine delivery using heat-labile vaccine and centralised vaccination teams were
inappropriate for such areas.

JP15 recognised this and chose to wall off these difficult areas with a cordon sanitaire and
wait until conditions improved (Atang and Plowright, 1969). Unfortunately these remaining endemic
areas acted as a source of an expensive epidemic of rinderpest which spread across West, Central and
East Africa in the early 1980's. The on going Pan African Rinderpest Campaign (PARC) started in
198615 and is based upon lessons learnt from JP15. PARC is geared toward eradication of rinderpest
through not only conventional vaccination services but a policy reform program which includes
privatisation of veterinary services and the use of relatively novel initiatives such as community-based
vaccinators and contract vaccinator services. PARC has now reached a stage similar to the end stage
of JP15. Rinderpest has not been reported in West and Central Africa since 1988 and the remaining
endemic foci are thought to be confined to southern Sudan, areas of western Ethiopia bordering
Sudan, the Awash valley in NE Ethiopia and the Karamajong area on the Kenyan Ugandan border.
These areas have been designated “Special Action Areas” by PARC and rather than try to contain
them PARC is actively promoting new approaches to control and finally eradicate rinderpest from
these areas. The approaches being taken by PARC use Participatory Rural Appraisal (PRA) and
community participation of the affected populations. These new approaches promote decentralised,
community-based and privatised vaccination and animal health services.

This paper aims to show that these novel approaches formulated for the special action areas,
when viewed in the wider context of the evolution of development strategies over the past 30 years,
are a natural choice for use in such areas. They are likely to become more accepted and the
methodology stronger with time. The participatory rural appraisal and community-based approach is
still being developed in terms of rinderpest control. One of the special action areas where this is most
advanced is southern Sudan. This paper uses southern Sudan as a briefcase study to outline some of
the methods being used and some of the lessons so far learnt (Leyland, forthcoming).

2. Characteristics of Special Action Areas

In developing an appropriate rinderpest vaccination program for these special action areas,
it is worth looking more closely at the particular characteristics of these areas. They tend to have
many of the following characteristics:-

They are areas where the limitations such as climate (rainfall and temperature) or topography
restrict the use of land to extensive grazing of natural pastures rather than cultivated pastures
or crops;

They are remote, often inaccessible by road and distant from centralised services;
They are inhabited by transhumant agro-pastoral people who generally see their agricultural
work as a supplement to their livestock-raising activities and/or are inhabited by nomadic
pastoral people;

The inhabitants decision making processes are complex as they take into account climate,
economic considerations (both monetary and non-monetary), social concerns, political factors,
legal constraints or incentives and other ecosystem variables (Prior 1994).

They have recently been or are experiencing civil conflict, resulting in insecurity,
displacement of people, loss of assets, greater need to remain mobile and to varying degrees
breakdown or stress to traditional social structures.

They are marginalised in that the inhabitants have had relatively little development contact
in terms of education, outside trade and government services including veterinary services.

The inhabitants may have already experienced top down or poorly planned development
projects - which did not consult them.

The inhabitants have a well established traditional way of life which they are disinclined to
change.

These characteristics have often precluded the successful implementation of conventional
vaccination projects. These projects tend to have a ‘top-down’ approach with pre-determined targets
for vaccination coverage and sero-surveillance results, a tight time schedule for pre-defined activities
and contact with communities is primarily only through local officials. Such a model fails to
accommodate the dynamics of special action areas and lacks the inherent flexibility required to work
in such areas. A typical example is of centrally organised mobile teams of non-local vaccinators who
do not know or fully understand the complexities affecting the local inhabitants because they only visit
an area once or twice a year and who are likewise not known well enough by the locals to be trusted
and listened to.

This paper argues that to carry out a successful rinderpest eradication program, in a special
action area, a strong understanding of the complexities of the area and positive interaction and
dialogue with a substantial cross-section of the local communities is required. In addition, given the
logistics and expense of mounting a conventional vaccination program, it can be more cost-effectively
done by relying on community-based vaccinators and local resources rather than on outside teams.
It the case of South Sudan, a participatory approach using “Participatory Rural Appraisal” (PRA)
tools and community-based vaccinators is leading to significant widespread vaccinations of cattle and
far fewer outbreaks of rinderpest, even though the area is riven by civil strife. The next section details
the development and value of the “Participatory Rural Appraisal” approach.

3. The evolution of Participatory Rural Appraisal

In the early 1970s the green revolution in India was considered a success because it had
increased yields of wheat and rice over large areas. However it soon became apparent that `green
revolutions' in other areas and sectors were not occurring. Many innovations proposed by agricultural
research were not being adopted by farmers in the complex, diverse and risk-prone environments of
resource-poor people. The reason for non-adoption was that generally the innovations were unsuitable
for the local agro-climatic and socio-economic circumstances (Kearl 1976). The doctrine grew that
research should be determined by explicit farmers' needs rather than by the preconceptions of
researchers (Simmonds 1985). This new doctrine was to develop into farming systems research (FSR)
in the late 1970s. FSR is primarily a diagnostic tool, providing a better understanding of the strengths
and weaknesses of existing production systems, which multi-disciplinary specialists can use to design
packages of improved agricultural inputs (Richards 1986). The packages aim to be farmer-centred,
holistic, on-farm, iterative and continuous (Maxwell 1986) and generally consist of four main phases:
a description of the problem; design of alternative technologies; validation of technologies and
recommendations on use of validated technologies.

According to Rhoades (1985), the euphoria among international development agencies for FSR
has unfortunately grown more rapidly than the appropriateness of its methods. The short comings of
FSR have been described by many authors (Harwood 1982; Biggs and Gibbon 1986; Rhoades 1985;
Biggs and Farrington 1990). Most of these centre on the initial systems survey and descriptive phase
eg. it consists of researchers' descriptions and not the farmers' own perceived way of doing things.
It tended to be “top down” and not “bottom up”, a bias which is considered a serious flaw in any
rural development strategy by many authors (Chambers, Pacey and Thrupp 1989, Farrington and
Martin 1988, Bunch 1987, Bernsten, Fitzhugh, and Knipscheer 1983, Scoones and Thompson 1994).
FSR projects tended also to be slow and expensive.

Improved information gathering with greater participation of farmers was introduced through
use of practical social science tools to carry out what is now generally known as a “Rapid Rural
Appraisal” (RRA). The basic RRA consisted of the following components:-

RRA has also been criticised (Beebe 1987) for the quality of information it gathers. However
the main criticism against RRA was that is does not necessarily increase the level of participation of
farmers in the projects RRA leads onto.

The growing recognition that participation by communities in development projects is required
for projects to succeed combined with the lessons learnt from the use of RRA in FSR led to the
development of interactive data gathering and planning tools which have become known as
Participatory Rural Appraisal (PRA) tools (McCracken Pretty and Conway, 1988).

Participatory rural appraisal tools are designed for use with standard RRA tools. They should
be used by the farmers themselves, either in dialogue with outsiders or among their communities. The
object is to permit them to better record, count, measure, problem pose, discuss and analyse their
existing situation with the aim of:-

building on what people already know;

using and developing people's abilities and skills to analyse and evaluate their surroundings;

reveal whether human and material resources are being used efficiently and effectively;

help people to analyse their individual situations and see how their activities may be altered
in a beneficial manner, thus setting local priority needs;

enable people to study their own methods of organisation and management;

provide good information for making decisions about planning and programme direction;

increase the sense of collective responsibility for programme development, implementation,
monitoring and evaluation;

identify indicators for monitoring and evaluation to be recorded.

concluding with a community action plan also sometimes called a social contract, which sets
action priority order, identifies materials and labour required for implementation, assigns
responsibilities to groups during implementation. The plan is a focal point for all the data
gathering and ranking. The plan will focus community discussion in its preparation, mobilises
community groups during implementation, and helps communities to measure their own
progress toward achievement.

The commonly used tools are the following:-

Informal interviewing

Diagrams and mapping

Wealth ranking

Matrix ranking and scoring

Progeny histories

Creative Expression

(See Appendix 1 for very brief details on each tool)

All the above mentioned tools are powerful, relatively simple to use and can be (and have
been) taught to all types of project staff. The tools have recently started to be modified for specific
use in various sectors from urban welfare to pastoral livestock. For more detailed information on the
livestock techniques refer to RRA notes No. 20, special issue on Livestock 16.

One danger in using such tools is to forget or not understand that the reason for using these
tools is not for the facilitator to gather excellent information, but for the tools to be used to promote
participation by all groups which might be involved in any future project. This mistake is commonly
made. Training facilitators in the use of PRA tools must involve instruction on why greater
participation can lead to more success in project implementation.

4. Rinderpest control in Southern Sudan using a participatory approach

Southern Sudan is the most significant endemic rinderpest focus currently in Africa. It
neighbours pastoral areas of Uganda, Kenya, Chad and Ethiopia. It is the closest endemic foci to the
east west stock routes of the Fulani and Baggara tribes which start in Darfur province of Sudan and
Chad. It therefore poses the greatest risk to rinderpest spreading back to West Africa.

Southern Sudan is a war zone, the current war started in 1983. There has been only 11 years
of peace since independence was gained in 1956. It is the longest ongoing civil conflict in Africa with
over a million people killed and 2.5 million displaced, most of them civilians. Southern Sudan is what
is known in current development jargon as a “complex emergency”. The infrastructure of the area
has broken down, mechanised internal transport is almost impossible, the cash economy is often not
present, schools and hospitals barely function, abuses of human rights have been experienced by the
civil population, animal health services lack trained personnel and resources. Southern Sudan is one
of PARC's Special Action Areas.

UNICEF as the lead agency of Operation Lifeline Sudan, began to facilitate rinderpest
vaccination in southern Sudan in 1989. The majority of the livestock project sites were and still are
in rebel controlled areas because that is where most of the livestock are located. One of UNICEF's
roles is to ensure the rights of the child to “adequate nutritious foods” (article 24, 2, (C) UN
Convention on the rights of the child). Livestock and particularly cattle provide households with 25-40%
of their total food needs and this could rise to as high as 60%, depending on the number of
cattle and the season. Cattle also fulfil important social economic roles, such as the provision of status
to the owner, mobility, and wealth for marriage and bartering, which assists in stabilising war torn
communities.

The estimated cattle population for southern Sudan is 3.5-4 million. The UNICEF livestock project
vaccinated 1,135,000 cattle against rinderpest over the four years from 1989 to 1992. During this time
the project was vaccinating against 4 diseases using full cold chain and teams of vaccinators. The
project virtually came to a standstill in 1992 due to disruption of teams and cold chain from
insecurity. Only 140,000 cattle were vaccinated in that year.

4.1 The UNICEF / Tufts University Livestock Progam

In 1993 with technical assistance from Tufts University's Section of International Veterinary
medicine, UNICEF started a project of developing vaccination projects through community-based,
decentralised and privatised animal health services. An integral part of this service development was
the participation of local communities. In this year the program confirmed 11 outbreaks of rinderpest
and vaccinated 1,489,706 head of cattle, an increase of 10.6 times the 1992 figure and 244,706 over
target (Mariner, Akabwai, Leyland, Lefevre and Masiga 1994). In 1994, 4 outbreaks of rinderpest
were reported and 1,743,033 cattle were vaccinated, 343,033 over target. 1,070,927 cattle were
vaccinated against rinderpest in 1995, as per target, with 2 unconfirmed outbreaks of the disease. The
reduced 1995 figure compared to 1994, reflects poor security in certain key pastoral areas and a
greater emphasis on community dialogue and training to broaden the scope of the program to include
control of other major diseases. The target for 1996 is one million cattle vaccinated and there has
been one unconfirmed outbreak of rinderpest. The perception by the cattle owners and the local
authorities in southern Sudan is that the program has been successful in controlling rinderpest in those
areas vaccinated.

The 1993 program in southern Sudan started on the premise that the veterinary services had
broken down in the war affected areas. It accepted the rationale that by soliciting the participation of
the pastoral peoples an economically viable and socially acceptable animal health service could be
developed (Sollod and Stem 1991). It adopted a participatory approach.

The first contact with pastoral communities by the UNICEF vet in 1993 was by conducting a
Participatory Rural Appraisal. The PRA was carried out against a back-ground of severe malnutrition.
In March 1993 a nutrition survey of 3 distinct areas revealed that the percentage of children less than
five years old who were critically undernourished was on average 80% (Centres for Disease Control
and Prevention {CDC} 1993). This was caused by displacement, crop failure and livestock disease.
In such times the pastoral people rely on their cattle's milk to keep the children and old people alive.

The particularly useful PRA tools used were informal interview, disease problem ranking with
disease descriptions, mapping on the ground with sticks and stones, seasonal calendars and group
discussion. Rinderpest was ranked by the cattle owners as the biggest problem disease in every
location visited. The population was therefore extremely enthusiastic to participate in control of
rinderpest, as can be seen from the following quotes:-

Head chief, Leek, Western Upper Nile Province.

Cattle and human diseases are related. Our lives revolve around our cattle. If our cattle die then we
start to think about the future of our children and we cry. Sometimes if our cattle die we have to move
away from our areas for example to Khartoum…. We like the idea of training people from our
communities {to help keep the cattle alive}….

Head chief, Ganyiel, Western Upper Nile Province.

The cow is considered to be our grand mother. You see me now, I am alive because of the cow. I do
not take beer and the best drink is milk. I have 38 wives, these wives where not enslaved but bought
with cows in good times. The idea of training people in our communities is a very good one…. The
cow is like a human. If our wife is infertile we struggle to take her to the hospital. It is the same for
our cows because without our cows our children will die. We must particularly fight the diseases
which kill our young cows.

Head chief, Ler, Western Upper Nile Province.

If you want to write you look for a pen. If you want to live you look for a cow. The issue we have
been discussing is as important as the Lau / Jikany conflict. We agree with the ideas suggested. When
the committees are formed they must include more people, not just the chiefs and the vet staff.

A community action plan was drawn up in each area. UNICEF's main contribution was
training and equipping vaccination teams. The local authorities, chiefs and cattle owners organised
the selection of vaccinators and the movement of vaccination teams around the local areas. The
vaccinators were paid by both the cattle owners in terms of milk, goats and bulls and by UNICEF
in terms of soap and salt. Because of the severe malnutrition the 1993 the community action plans
were necessarily done fast and mistakes were made. The major mistakes were in terms of not
spending enough time contacting all the cattle owners' representatives and agreeing the community
action plan with them, of allowing the selection of vaccinators to be dominated by local authorities
and of not having vaccination guidelines particularly suited to southern Sudanese conditions eg.
uniform ear notching policy.

The community-based approach adopted could not have been possible without the introduction
of thermostable Vero cell-adapted rinderpest vaccine by UNICEF in 1993. This vaccine has not only
had a significant impact on the control of rinderpest in southern Sudan but is also now being used
effectively in Ethiopia, Somalia and Chad as described by Mariner et al 1994. The value of the
vaccine is immediately apparent to cattle owners.

Head chief, Mogok, Jonglei Province.

Greetings to you. We are very interested in the issues you have raised. Today's meeting is one of the
most important that we have had during our time in Akobo and we will take great care to report it
to our communities. Any talk about saving the lives of cattle will concern the saving of the lives of our
children and the livelihood of future generations. The new ideas you have mentioned will improve the
vet services in our areas. One of the biggest achievements of this meeting is our learning that we will
abandon the use of fridges. Last year our cattle could not be vaccinated because they are 5-6 days
walk from Ayod, indeed vaccines that were brought to us could not be used because they spoiled in
the cold box. Overcoming this problem is very important for us. We will have no problem in recruiting
people to do this work.

Since 1993, UNICEF, the local authorities and the communities learnt a lot from their
mistakes. This learning process is one of the strengths of participation. Participation can allow the
on going dialogue, monitoring and feedback for the projects to be flexible and responsive enough to
meet the needs of all parties. For example, the UNICEF livestock program now encourages continued
community dialogue through PRA after the development of the initial community action plan and the
first training of Community Animal Health Workers (CAHW). This was in response to the fact that
all parties learn a lot in the two months after the initial implementation of health services, and a
revision of the community action plan is often called for if the animal health service is the remain
workable.

The UNICEF/Tufts livestock program had one veterinarian working for it in 1993. In 1994
and 1995 there was change in policy for the program to not just work for rinderpest control but to
broaden the scope of the animal health service to include the other major diseases occurring in
southern Sudan. The service has remained community-based, decentralised and privatised. The main
implementors are a cadre of CAHWs selected by and working for their communities. The CAHWs
are paid a proportion of the revenue they collect from the sale of their treatment and vaccination
services. It is the CAHWs who carry out rinderpest vaccination using thermostable vaccine. This can
be done as individuals within their communities or the CAHWs may be coordinated by the local
authorities to come together as a team to vaccinate against rinderpest or other diseases such as anthrax
or CBPP. To help expand the program Non Government Organisations (NGOs) with their greater
staff capacity were invited to participate in the Operation Lifeline Sudan (OLS) livestock program.

The process of establishing the initial and subsequent community action plans involves a
significant amount of staff time in the field. UNICEF therefore provides, as well as its own
implementing role, a coordination and advisory role for the NGOs and counterparts. UNICEF also
purchases vaccine, equipment and medicines. In effect UNICEF acts on behalf of its Sudanese
counterparts rather like a veterinary authority. The process of attracting Sudanese veterinary doctors
back to southern Sudan to take over from UNICEF is on going.

At present there are currently 10 NGOs working in southern Sudan under the OLS livestock
program, covering approximately 70% of the pastoral areas. It is hoped that security permitting the
other 30% of the pastoral areas can be reached in the next few years. UNICEF has seven livestock
officers. In May 1996 UNICEF and Tufts University started a similar livestock project in Khartoum
also working with NGOs and the government veterinary services.

4.2 Major Lessons Learnt

The UNICEF/Tufts livestock program for southern Sudan has remained participatory in
approach and continues to learn lessons. By broad themes, some of the major ones are as follows:-

Community Dialogue:

Do not under estimate the time needed in carrying out the community dialogue, using PRA
tools, which is necessary to gain a working community action plan. On average this process
takes 2 months and has taken up to one year. The period required depends upon the
demography of the area and the amount of time the facilitators can spend in the location.

It is vital that all the representatives of the cattle owners are aware of the plan or social
contract. It is not good enough to deal with Chiefs alone.

The respect for and influence of the chiefs should not be underestimated.

Do not expect anyone to work for nothing.

Continue community dialogue to make adjustments to the community action plan once the
project has trained the first CAHWs and has started implementing health services.

Reach consensus with cattle owners on difficult policy issues such as, cost of vaccination,
which animals should be vaccinated, ear notching and how long vaccination should continue
for, who should accommodate CAHWs when they visit.

Do not be tempted to start implementing animal health activities before a social contract or
community action plan between the outside organisation eg. NGO, the local authorities, and
the cattle owner's has been agreed.

Training:

Do not underestimate the ability of pastoral people to grasp new concepts and be trained to
implement novel activities. eg. the training of illiterate livestock owners as Community-based
Animal Health Workers (CAHWs), who record their activities pictorially, charge for their
services and mobilise stock owners.

Use local perceptions of what causes disease to build cattle owners understanding of how
vaccine works and why vaccination must continue after the disease in no longer seen in the
area.

Do not neglect to build CAHW refresher training into projects.

To speed up the process of establishing community-based animal health services - develop
guidelines for a model which can be used by local veterinary authorities and NGOs. The
guidelines should include training curricula for courses, topic reminders for community
dialogue and extension tools which can be used.

Capacity Building:

Build on existing social structures.

Accept that the process of establishing community-based services is a learning process for all
parties in order to keep the projects flexible and responsive.

Be constantly aware of capacity building work required for the local authorities to continue
to operate the privatised and community-based approach. The local veterinary authorities in
southern Sudan have fully accepted the approach and are being trained to continue with it.

Establish training institutions for the next generation of local veterinary authorities, with
curricula targeted to develop privatised veterinary services.

Privatisation:

Build drug supply, cold chain management, coordination of vaccination using non heat stable
vaccines and monitoring activities such as sero-surveillance into the local veterinary
authorities role.

Ensure regular supply of drugs through local suppliers.

Link the incentives that the CAHWs and the veterinary coordinators receive to the amount
of work carried out, through payment for services.

Keep book keeping and monitoring as simple as possible.

Do not provide rinderpest vaccine free of charge.

Do not subsidise.

Allow CAHWs to become more mobile by encouraging them to purchase bicycles.

Target locally perceived disease problems which can be practically controlled or treated.

Guidelines for the Operation Lifeline Sudan animal health service model are currently being
collated as a working document. (UNICEF OLS 1996, ongoing).

5. Conclusion

PARC and its partner organisations are developing new approaches to working in the special
action areas which are the remaining endemic foci of rinderpest in Africa.

Given the characterstics and challenges posed by these areas it is suggested that a community-based
participatory approach is an approach is an appropriate one for such complex, remote and risk prone areas.

A participatory approach to developing vaccination and animal health services is being started
in some of these special action areas. This process has been given impetus by the development of a
thermostable vaccine which can be used without a cold chain for one month and which maintains the
safety and efficacy of traditional tissue culture rinderpest vaccine (Mariner et al, 1990a, Mariner et
al 1990b).

Southern Sudan is one area where, despite the severe logistical problems of working in a war zone,
such an approach has proven successful in controlling rinderpest. The participation of communities
is facilitated using simple Participatory Rural Appraisal (PRA) tools. Community action plans which
reflect local conditions are being developed on an area by area basis to evolve community-based,
decentralised and privatised animal health services. This is a continuing learning process for all the
parties involved. Acceptance that this is a continuing learning process gives strength to the projects.
It allows them to remain flexible and responsive enough to find success in areas which are considered
to be marginalised and have seen little development. The lessons so far learnt in southern Sudan are
already being used within that area but can also be used to assist projects starting in other special
action areas. The resulting community-based animal health services are cost effective and sustainable.
They could be used to finally eradicate rinderpest from Africa and also go on to assist in similar
inaccessible areas as part of the Global Rinderpest Eradication Programme.

Beebe, J. (1987). Rapid Appraisal: The Evolution of the Concept and the Definition of the Issues. In,
Proceedings of the 1985 International Conference on Rapid Rural Appraisal, Khon Kaen, Thailand: 47–68.

Biggs, S. D. and Farrington, J. (1990). Assessing the Affects of Farming Systems Research: Time for the
Reintroduction of a Political and Institutional Perspective. 19–22 November 1990. Asian Farming Systems
Research and extension Symposium, Asian Institute of Technology, Bangkok, Thailand.

Interviewing is the oldest and most respected manner of information gathering and the
foundation for many other tools. It is a skill that should not be taken for granted and training is often
required. It is useful to use check lists for when interviewing and ensuring the interviewers are aware
of local cultural sensitivities. Mitchel and Slim (1991 and 1992)

DIAGRAMS AND MAPPING

Diagrams are any simple schematic device which presents information in a readily
understandable form. In rural communities they capture and present information which would be less
precise, less clear, and much less succinct if expressed in words. Diagrams and maps are constructed
using shared information which can be checked, discussed, and amended and thus creates a consensus
and facilitates communication between different people. They include:-

maps

farm profiles and sketches

transects

models and seasonal calendars

flow diagrams

decision trees

venn diagrams

time lines

WEALTH RANKING

This tool uses the perceptions of informants to rank ‘household’s within a village or part of
a village (community) according to overall wealth. This is a very useful and powerful tool. It allows
outsiders to gain an in-depth understanding of community structure. It is easily used to promote
discussion on problems the community faces. I promotes culturally sensitive targeting of interventions.

MATRIX RANKING AND SCORING

Matrix ranking and scoring is used to discover local attitudes to and perceptions of a topic
of interest. This may be ranking of diseases, ethnic treatments, worst case scenario plans etc. The
exercise is valuable to promote discussion within groups.

PROGENY HISTORIES

These are individual animal case studies. They rely on the pastoralist's intimate knowledge
of the pedigree and fate of every animal in his or her herd. Progeny histories are very useful for
building up an accurate quantitative view of mortality rates, reasons for death, offtake rates, reasons
for offtake etc.

CREATIVE EXPRESSION

Creative expression involves the use of art forms as a means for individuals and groups to
represent their ideas and/or feelings. Artistic forms that are commonly used include drawing, drama,
role plays, music, and collages. It is important that the participants use the art form with which they
are familiar. Role play is particularly powerful in pastoral societies.